Kidney nontumor / medical renal
General
Biopsy
Author: Nikhil Sangle, M.D.
Last author update: 2 April 2012
Last staff update: 15 June 2022
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Kidney biopsy
Table of Contents
Definition / general | Diagrams / tables | Procedure | Microscopic (histologic) images | Immunofixation | Electron microscopy descriptionCite this page: Sangle N. Biopsy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneybiopsy.html. Accessed September 30th, 2023.
Definition / general
- Helps establish diagnosis and determine prognostic factors for renal disorders and transplant recipients
- Needle core or open biopsies are relatively safe and only rarely cause morbidity or mortality; outpatient complication rate is 8% (Clin Nephrol 2011;76:464)
- Also important for appropriate management of elderly and very elderly patients with kidney disease (Adv Chronic Kidney Dis 2012;19:61)
- Percutaneous ultrasound guided renal biopsy is safe, reliable and effective in children; most common indication is steroid resistant, steroid dependent or frequent relapsing idiopathic nephrotic syndrome (Hippokratia 2011;15:258)
- Pathology should correlate complete clinical and laboratory information (using a clinical form is recommended) with light microscopy, immunofluorescence and electron microscopy; cannot diagnose certain diseases without immunofluorescence or EM (Mod Pathol 2004;17:1555)
- Must carefully evaluate glomeruli, tubules, interstitium and vessels
Diagrams / tables
Images hosted on other servers:
Dividing up core tissue
if no dissecting
microscope is present
Procedure
- Specimen must be handled gently
- Don’t: use forceps, pull or stretch tissue, place tissue on dry gauze or water soaked gauze, freeze entire sample or place on ice cold saline
- Do: transport with tissue culture medium on saline moistened gauze; cut with fresh scalpel
- Dissecting microscope helps assess adequacy of glomeruli; place sample on glass slide with saline
- Two cores recommended
- Core #1: take samples 0.5 to 1.0 mm thick from each end with razor / scalpel and put in glutaraldehyde for EM; place remainder in saline, then fixative for light microscopy
- Core #2: take samples for EM, snap freeze the remainder for immunofluorescence
- Wrap light microscopy specimens in lens paper prewetted with fixative (avoid sponges or plastic embedding bags)
- If only one core or a small specimen is obtained, use tissue for EM and immunofluorescence because EM semi thin sections can also provide light microscopic information
- Fixative: mercury fixatives (Zenker, Bouin, other) provide optimal architectural and cytologic detail; ethanol fixation helps find glycogen or crystals of urate / uric acid
- Recommended to section through entire specimen, put 3 - 4 sections on each slide; for every batch of 5 slides, stain 1 with H&E, 1 with PAS and keep 3 unstained slides for possible future use
- Can detect immune complexes with antibodies or using fluorescence microscopy of H&E stained sections, fixed in Hollande fixative (Mod Pathol 2002;15:988)
Microscopic (histologic) images
Images hosted on other servers:
A: renal cortex with
round red glomeruli;
B: renal medulla
without glomeruli
Immunofixation
- Best performed on unfixed, frozen sections
- Examine for IgG, IgM, IgA, IgH, C3, C1q, C4, fibrin, kappa and lambda
- Should include positive and negative controls for each run
- Immunoperoxidase may be a substitute (cheaper, can correlate with H&E, doesn’t fade) but complement antigens are difficult to detect, may have higher background staining
- Minimum glomeruli:
- 5 - 10 in general
- 10 for crescentic disorders
- 1 may be sufficient for diffuse lesions such as membranous glomerulonephritis
- Immunohistochemistry: IgG, IgA, IgM, C1q, C3, C4, fibrinogen and fibrin
- Frozen section: requested to determine adequacy (% sclerotic glomeruli) in donor kidney for transplant
- Transplant biopsies: performed to assess rejection
Electron microscopy description
- Uses osmium tetroxide or glutaraldehyde for fixation (cannot perform if tissue exposed to B5, Zenker or other mercury based fixatives; can reprocess tissue from paraffin block)
- Embed in epoxy resin stain semithin (one micron thick) sections with toluidine blue or methylene blue
- Obtain thin sections for EM stained with uranyl acetate and lead citrate
